We Have A Serious Antibiotics Problem

In this excerpt from his new book, Mind Over Meds, Dr. Andrew Weil examines the power and danger of these popular medications.

Antibiotic resistance is now so widespread that it's considered a major threat to public health. In many ways we're now in a worse relationship with disease-causing bacteria than we were before we had antibiotics—a calamity entirely of our own making.

Antibiotics are prescribed to prevent the progression of bacterial infections, including ear infections, strep throat, urinary tract infections, sexually transmitted diseases like syphilis and gonorrhea, Lyme disease and associated tick-borne infections, and acne. Sometimes they're prescribed in the absence of an infection as a preventive measure—for instance, to prevent infection following surgery. They don't treat viruses.

Unfortunately, even when they're prescribed appropriately, taking antibiotics is not without serious drawbacks.

Misusing Antibiotics
Doctors have been routinely prescribing antibiotics for minor bacterial infections; for the prevention of infections; for traveler's diarrhea and other gastrointestinal ailments; for the long-term treatment of acne, rosacea, and other conditions that may or may not be due to bacterial infection; and, worst of all, for viral illnesses, for which antibiotic therapy is pointless.

Patients with viral upper respiratory infections commonly demand antibiotics when they don't get better quickly, and too often doctors comply.

Bacteria can evolve to resist an antibiotic, then survive to pass on their genetic mutations to the next generation of disease-causing organisms. This can happen very fast, because bacteria reproduce rapidly. The body becomes a factory for generating resistant organisms that go out into the world to cause trouble for all of us—a consequence that is particularly regrettable when the use of the drug is not justified. In 2009, Americans spent almost $11 billion on antibiotic therapy. Resistant infections now account for $20 billion in annual health care costs.

Your body contain 10 times more bacterial cells than human cells. Most of those bugs are helpful ones, concentrated in your intestines.

ANDRZEJ WOJCICKI/SCIENCE PHOTO LIBRARY

Disrupting the Body's Balance
Overuse of antibiotics not only changes bacterial organisms, which mutate to resist them, but also has harmful effects on the human body. We have 10 times more bacterial cells than human cells in our bodies, and most of these bacteria are found in the intestines, where they help us digest food and synthesize vitamins. They also help fortify our defenses against germs.

Even a single course of antibiotics can permanently upset the body's balance of these gut microbes, conceivably preventing the immune system from distinguishing between harmless compounds and real attacks. Poorly balanced gut flora can make the mucosal lining more permeable, allowing large molecules that normally stay within the gut to leak into the blood, which in turn induces immune responses that can lead to allergies, autoimmunity, and even cancer.

A Better Defense Against Infection
Some of the most effective approaches to avoiding illness are simple, including washing your hands with soap and staying home when you're sick. Isolating yourself until you feel well not only reduces your chance of exposing others when you're most contagious but also allows you to rest and recover faster. Scrubbing your hands with plain old soap and warm water for 20 seconds works as well as applying hand sanitizer to prevent infection.

The long-held belief that all microbes are dangerous is far from correct. The bacteria, viruses, fungi, and even parasites that live in and on us keep one another in balance. It can indeed be dangerous or even deadly for any one microbial population to multiply unchecked.

While we previously thought that the answer was to purify—our bodies with antibiotics and hand sanitizers and our environments with bleach and other disinfectants—it turns out that constant exposure to an array of microorganisms is an effective defense against infection that may also reduce the risks of other health problems. From all we're learning, a body that's rich in microbial diversity is more resilient.

Antibiotics can be crucial to our health. They've saved countless lives. No matter how important their benefits, however, we must take into account their detrimental effects on short- and long-term health. Experts warn that we're coming to the end of the antibiotic era, as bacteria have now developed resistance to our latest and strongest drugs. The appearance of new superbugs may force us to explore other ways of preventing and fighting infection.

DRUG SMARTS

Dr. Weil's advice on when to take an antibiotic and when not to

Reserve antibiotics for treatment of severe bacterial infections.

Never take an antibiotic for an upper respiratory infection that is likely to be viral in origin, even if symptoms are severe and persistent (in which case you should speak with your doctor), unless a throat culture or other test indicates the presence of pathogenic bacteria. Do not pressure your doctor to prescribe an antibiotic for a viral infection.

Do not go on long-term antibiotic therapy for management of chronic skin, gastrointestinal, or respiratory ailments without carefully assessing the risk-benefit ratio.

If you eat meat, poultry, dairy products, or farmed fish, choose organic versions or ones certified to be free of antibiotics.

Learn to use natural products that are safe and effective treatments for minor infections, like tea tree oil for skin and periodontal problems and Oregon grape root for gastrointestinal upset.

ANDREW WEIL, MD, is founder and director of the Arizona Center for Integrative Medicine and clinical professor of medicine at the University of Arizona. Send your questions for Dr. Weil to askdrweil@prevention.com.

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